Delivery of Just-in-Time Information

James J. Cimino

Columbia University

Definitions• Just in time for:

– decision making• Decision making by:

– public health professionals– clinicians– patients

• Information:– databases– on-line resources– guidelines

Information Needs in Decision Making

?

Lessons from Medical Education

Case-Based Medical Education

Case-Based Decision Support• Information resources are computer-based

• “Case” is computer-based

• Information need is context dependent

Content

+ Context

+ Anticipated Need

Just-in-Time Information

Architecture and Infrastructure

• Data collection for guideline development

• Distribution mechanisms for information

• Monitor use and compliance

Standards and Terminology

• Structured guidelines and other resources

• Terminology and data elements for input

• Standard interface for retrieval

Best Practices, Research, Evaluation

• Best practices: need to be defined

• Research:– identify information needs in given context– identify information resources– the rest is easy

• Evaluation:– compliance– impact

Privacy, Confidentiality, Security

• Data for guideline creation

• Who is looking at what?

• What data are used to seed searches?

• What are they doing with the results?

Training and Workforce

• Public health: contribution to solutions

• Users: learn to use guidelines and practice evidence-based medicine

Funding and Policy

• Content creation

• Development

• Access/support

• Incentives

Conclusions

• JITI is doable and should be done

• Understanding the needs is the hardest part

• Different constituencies and contexts

• Reuse resources